I am fully aware that the amount charged is non-refundable and I accept the sale and final with no refund. Yes, I agree to terms.

Full Name*

(As it appears on the Credit Card)

Telephone numbers(Optional)

HOME #

CELL #

WORK #

Credit Card Information

Email Address:*

Name Exactly as it Appears on Credit Card:*

Exact Billing Address of Credit Card

Street*

City:*

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Country:*

Type Of Credit Card:*

Master Card
Visa Card Amex

Card Number:*

CVV Code:

(CVV code is the Security Code on the back of the Credit Card)

* Please enter card number without spaces.
TO INSURE SECURITY TO YOUR CREDIT CARD DATA -DO NOT enter the last four numbers of the credit card.
E-mail the last four numbers to dmiddl5543@aol.com by separate e-mail.
Or call Dot at 832-434-1316